• Asia pacific journal of information systems
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• v.20 no.3
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• pp.139-166
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• 2010

The supply chain management (SCM) systems have emerged as strong managerial tools for manufacturing firms in enhancing competitive strength. Despite of large investments in the SCM systems, many companies are not fully realizing the promised benefits from the systems. A review of literature on adoption, implementation and success factor of IOS (inter-organization systems), EDI (electronic data interchange) systems, shows that this issue has been examined from multiple theoretic perspectives. And many researchers have attempted to identify the factors which influence the success of system implementation. However, the existing studies have two drawbacks in revealing the determinants of systems implementation success. First, previous researches raise questions as to the appropriateness of research subjects selected. Most SCM systems are operating in the form of private industrial networks, where the participants of the systems consist of two distinct groups: focus companies and vendors. The focus companies are the primary actors in developing and operating the systems, while vendors are passive participants which are connected to the system in order to supply raw materials and parts to the focus companies. Under the circumstance, there are three ways in selecting the research subjects; focus companies only, vendors only, or two parties grouped together. It is hard to find researches that use the focus companies exclusively as the subjects probably due to the insufficient sample size for statistic analysis. Most researches have been conducted using the data collected from both groups. We argue that the SCM success factors cannot be correctly indentified in this case. The focus companies and the vendors are in different positions in many areas regarding the system implementation: firm size, managerial resources, bargaining power, organizational maturity, and etc. There are no obvious reasons to believe that the success factors of the two groups are identical. Grouping the two groups also raises questions on measuring the system success. The benefits from utilizing the systems may not be commonly distributed to the two groups. One group's benefits might be realized at the expenses of the other group considering the situation where vendors participating in SCM systems are under continuous pressures from the focus companies with respect to prices, quality, and delivery time. Therefore, by combining the system outcomes of both groups we cannot measure the system benefits obtained by each group correctly. Second, the measures of system success adopted in the previous researches have shortcoming in measuring the SCM success. User satisfaction, system utilization, and user attitudes toward the systems are most commonly used success measures in the existing studies. These measures have been developed as proxy variables in the studies of decision support systems (DSS) where the contribution of the systems to the organization performance is very difficult to measure. Unlike the DSS, the SCM systems have more specific goals, such as cost saving, inventory reduction, quality improvement, rapid time, and higher customer service. We maintain that more specific measures can be developed instead of proxy variables in order to measure the system benefits correctly. The purpose of this study is to find the determinants of SCM systems success in the perspective of vendor companies. In developing the research model, we have focused on selecting the success factors appropriate for the vendors through reviewing past researches and on developing more accurate success measures. The variables can be classified into following: technological, organizational, and environmental factors on the basis of TOE (Technology-Organization-Environment) framework. The model consists of three independent variables (competition intensity, top management support, and information system maturity), one mediating variable (collaboration), one moderating variable (government support), and a dependent variable (system success). The systems success measures have been developed to reflect the operational benefits of the SCM systems; improvement in planning and analysis capabilities, faster throughput, cost reduction, task integration, and improved product and customer service. The model has been validated using the survey data collected from 122 vendors participating in the SCM systems in Korea. To test for mediation, one should estimate the hierarchical regression analysis on the collaboration. And moderating effect analysis should estimate the moderated multiple regression, examines the effect of the government support. The result shows that information system maturity and top management support are the most important determinants of SCM system success. Supply chain technologies that standardize data formats and enhance information sharing may be adopted by supply chain leader organization because of the influence of focal company in the private industrial networks in order to streamline transactions and improve inter-organization communication. Specially, the need to develop and sustain an information system maturity will provide the focus and purpose to successfully overcome information system obstacles and resistance to innovation diffusion within the supply chain network organization. The support of top management will help focus efforts toward the realization of inter-organizational benefits and lend credibility to functional managers responsible for its implementation. The active involvement, vision, and direction of high level executives provide the impetus needed to sustain the implementation of SCM. The quality of collaboration relationships also is positively related to outcome variable. Collaboration variable is found to have a mediation effect between on influencing factors and implementation success. Higher levels of inter-organizational collaboration behaviors such as shared planning and flexibility in coordinating activities were found to be strongly linked to the vendors trust in the supply chain network. Government support moderates the effect of the IS maturity, competitive intensity, top management support on collaboration and implementation success of SCM. In general, the vendor companies face substantially greater risks in SCM implementation than the larger companies do because of severe constraints on financial and human resources and limited education on SCM systems. Besides resources, Vendors generally lack computer experience and do not have sufficient internal SCM expertise. For these reasons, government supports may establish requirements for firms doing business with the government or provide incentives to adopt, implementation SCM or practices. Government support provides significant improvements in implementation success of SCM when IS maturity, competitive intensity, top management support and collaboration are low. The environmental characteristic of competition intensity has no direct effect on vendor perspective of SCM system success. But, vendors facing above average competition intensity will have a greater need for changing technology. This suggests that companies trying to implement SCM systems should set up compatible supply chain networks and a high-quality collaboration relationship for implementation and performance.

• Journal of Preventive Medicine and Public Health
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• v.18 no.1
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• pp.99-112
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• 1985

It was measured to check the state of health education by the survey of the items related to the health with the first grade of students in middle school who mastered elementary courses. Totally 50 questions, which were selected from Standard and Dong-A reference books, were given to teachers and have got answered by the students who were totally 959(491 from urban areas and 468 from rural areas). It's done just after they entered middle school for a month, from April 10 to may 10, 1984. There were totally 782 items of health in all subjects of all grades. In contents, the most cases were about mental and emotional health(17.7%), exercise and rest (15.1%), environmental health, health life, personal health care, nutrition and foods, social health and organization, physiology and anatomy, statistics of public health population problem, disease and care, food sanitation, school health, parasitic and communicable disease control, eugenics and heredity(0.4%), etc were followed. In subjects, Korean language had 44.7% of mental and emotional health in 114 cases, arithmetics 46.4% of statistics of public health in 26, sociology, 23.1% of environmental health in 118, natural science, 60.1% of physiology and anatomy in 30, ethics, 40.3% of mental and emotional health in 176, music, 21.8% of mental and emotional health and accidents in 23, art, 42.9% of exercise and rest in 28, physical education, 38.6% of exercise and rest in 201, practical course, 36.2% of nutrition and foods in 61, and there was nothing but only one case in Korean history. Subjects in total cases of health informing items are below: Physical education 25.8, ethics 22.5%, sociology 15.1%, Korean language 14.6%, practical course 7.8%, natural science 3.8%, art 3.6%, arithmetics 3.3%, music 2.9%, Korean history 0.6%. Grades in total cases of health informing items are belows: the sixth grade 29.1%, the fourth grade 21.2%, the fifth grade 18.9%, the third grade 11.6%, the first grade 11.5%, the second grade 7.7%. The sections related to health matters were average 35.4%. According to the grades, the fourth and the sixth grade were 38.2% each other, the highest, and the second grade was 29.3%, the lowest. All scetions in physical education included them. The acceptability to the knowledge for health was belows: 56.3% in urban students and 53.9% in rural students. There was some difference in acceptability between two parties (p<0.005).

• Tuberculosis and Respiratory Diseases
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• v.66 no.3
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• pp.192-197
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• 2009

Background: Despite the benefits of home oxygen therapy in patients suffering chronic respiratory failure, previous reports in Korea revealed lower compliance to oxygen therapy and a shorter time for oxygen use than expected. However, these papers were published before oxygen therapy was covered by the national insurance system. Therefore, this study examined whether there were some changes in compliance, using time and other clinical features of home oxygen therapy after insurance coverage. Methods: This study reviewed the medical records of patients prescribed home oxygen therapy in our hospital from November 1, 2006 to September 31, 2008. The patients were interviewed either in person or by telephone to obtain information related to oxygen therapy. Results: During study period, a total 105 patients started home oxygen therapy. The mean age was 69 and 60 (57%) were male. The mean oxygen partial pressure in the arterial blood was 54.5 mmHg and oxygen saturation was 86.3%. Primary diseases that caused hypoxemia were COPD (n=64), lung cancer (n=14), Tb destroyed lung (n=12) and others. After oxygen therapy, more than 50% of patients experienced relief of their subjective dyspnea. The mean daily use of oxygen was 9.8${\pm}$7.3 hours and oxygen was not used during activity outside of their home (mean time, 5.4${\pm}$3.7 hours). Twenty four patients (36%) stopped using oxygen voluntarily 7${\pm}$4.7 months after being prescribed oxygen and showed a less severe pulmonary and right heart function. The causes of stopping were subjective symptom relief (n=11), inconvenience (n=6) and others (7). Conclusion: The prescription of home oxygen has increased since national insurance started to cover home oxygen therapy. However, the mean time for using oxygen is still shorter than expected. During activity of outside their home, patients could not use oxygen due to the absence of portable oxygen. Overall, continuous education to change the misunderstandings about oxygen therapy, more economic support from national insurance and coverage for portable oxygen are needed to extend the oxygen use time and maintain oxygen usage.

• Journal of Distribution Research
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• v.17 no.1
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• pp.87-115
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• 2012

Introduction: In these days, a loyalty program is one of the most common marketing mechanisms (Lacey & Sneath, 2006; Nues & Dreze, 2006; Uncles et al., 20003). In recent years, Coalition Loyalty Program is more noticeable as one of progressed forms. In the past, loyalty program was operating independently by single product brand or single retail channel brand. Now, companies using Coalition Loyalty Program share their programs as one single service and companies to participate to this program continue to have benefits from their existing program as well as positive spillover effect from the other participating network companies. Instead of consumers to earn or spend points from single retail channel or brand, consumers will have more opportunities to utilize their points and be able to purchase other participating companies products. Issues that are related to form of loyalty programs are essentially connected with consumers' perceived view on convenience of using its program. This can be a problem for distribution companies' strategic marketing plan. Although Coalition Loyalty Program is popular corporate marketing strategy to most companies, only few researches have been published. However, compared to independent loyalty program, coalition loyalty program operated by third parties of partnership has following conditions: Companies cannot autonomously modify structures of program for individual companies' benefits, and there is no guarantee to operate and to participate its program continuously by signing a contract. Thus, it is important to conduct the study on how coalition loyalty program affects companies' success and its process as much as conducting the study on effects of independent program. This study will complement the lack of coalition loyalty program study. The purpose of this study is to find out how consumer loyalty affects affiliated brands, its cause and mechanism. The past study about loyalty program only provided the variation of performance analysis, but this study will specifically focus on causes of results. In order to do these, this study is designed and to verify three primary objects as following; First, based on opinions of Switching Barriers (Fornell, 1992; Ping, 1993; Jones, et at., 2000) about causes of loyalty of coalition brand, 'brand attractiveness' and 'brand switching cost' are antecedents and causes of change in 'brand loyalty' will be investigated. Second, influence of consumers' perception and attitude prior to joining coalition loyalty program, influence of program in retail brands, brand attractiveness and spillover effect of switching cost after joining coalition program will be verified. Finally, the study will apply 'prior brand preference' as a variable and will provide a relationship between effects of coalition loyalty program and prior preference level. Hypothesis Hypothesis 1. After joining coalition loyalty program, more preferred brand (compared to less preferred brand) will increase influence on brand attractiveness to brand loyalty. Hypothesis 2. After joining coalition loyalty program, less preferred brand (compared to more preferred brand) will increase influence on brand switching cost to brand loyalty. Hypothesis 3. (1)Brand attractiveness and (2)brand switching cost of more preferred brand (before joining the coalition loyalty program) will influence more positive effects from (1)program attractiveness and (2)program switching cost of coalition loyalty program (after joining) than less preferred brand. Hypothesis 4. After joining coalition loyalty program, (1)brand attractiveness and (2)brand switching cost of more preferred brand will receive more positive impacts from (1)program attractiveness and (2)program switching cost of coalition loyalty program than less preferred brand. Hypothesis 5. After joining coalition loyalty program, (1)brand attractiveness and (2)brand switching cost of more preferred brand will receive less impacts from (1)brand attractiveness and (2)brand switching cost of different brands (having different preference level), which joined simultaneously, than less preferred brand. Method : In order to validate hypotheses, this study will apply experimental method throughout virtual scenario of coalition loyalty program if consumers have used or available for the actual brands. The experiment is conducted twice to participants. In a first experiment, the study will provide six coalition brands which are already selected based on prior research. The survey asked each brand attractiveness, switching cost, and loyalty after they choose high preference brand and low preference brand. One hour break was provided prior to the second experiment. In a second experiment, virtual coalition loyalty program "SaveBag" was introduced to participants. Participants were informed that "SaveBag" will be new alliance with six coalition brands from the first experiment. Brand attractiveness and switching cost about coalition program were measured and brand attractiveness and switching cost of high preference brand and low preference brand were measured as same method of first experiment. Limitation and future research This study shows limitations of effects of coalition loyalty program by using virtual scenario instead of actual research. Thus, future study should compare and analyze CLP panel data to provide more in-depth information. In addition, this study only proved the effectiveness of coalition loyalty program. However, there are two types of loyalty program, which are Single and Coalition, and success of coalition loyalty program will be dependent on market brand power and prior customer attitude. Therefore, it will be interesting to compare effects of two programs in the future.

• Journal of Global Scholars of Marketing Science
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• v.20 no.3
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• pp.262-268
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• 2010

Virtual communities (VCs) have developed rapidly, with more and more people participating in them to exchange information and opinions. A virtual community is a group of people who may or may not meet one another face to face, and who exchange words and ideas through the mediation of computer bulletin boards and networks. A business-to-consumer virtual community (B2CVC) is a commercial group that creates a trustworthy environment intended to motivate consumers to be more willing to buy from an online store. B2CVCs create a social atmosphere through information contribution such as recommendations, reviews, and ratings of buyers and sellers. Although the importance of B2CVCs has been recognized, few studies have been conducted to examine members' word-of-mouth behavior within these communities. This study proposes a model of involvement, statistics, trust, "stickiness," and word-of-mouth in a B2CVC and explores the relationships among these elements based on empirical data. The objectives are threefold: (i) to empirically test a B2CVC model that integrates measures of beliefs, attitudes, and behaviors; (ii) to better understand the nature of these relationships, specifically through word-of-mouth as a measure of revenue generation; and (iii) to better understand the role of stickiness of B2CVC in CRM marketing. The model incorporates three key elements concerning community members: (i) their beliefs, measured in terms of their involvement assessment; (ii) their attitudes, measured in terms of their satisfaction and trust; and, (iii) their behavior, measured in terms of site stickiness and their word-of-mouth. Involvement is considered the motivation for consumers to participate in a virtual community. For B2CVC members, information searching and posting have been proposed as the main purpose for their involvement. Satisfaction has been reviewed as an important indicator of a member's overall community evaluation, and conceptualized by different levels of member interactions with their VC. The formation and expansion of a VC depends on the willingness of members to share information and services. Researchers have found that trust is a core component facilitating the anonymous interaction in VCs and e-commerce, and therefore trust-building in VCs has been a common research topic. It is clear that the success of a B2CVC depends on the stickiness of its members to enhance purchasing potential. Opinions communicated and information exchanged between members may represent a type of written word-of-mouth. Therefore, word-of-mouth is one of the primary factors driving the diffusion of B2CVCs across the Internet. Figure 1 presents the research model and hypotheses. The model was tested through the implementation of an online survey of CTrip Travel VC members. A total of 243 collected questionnaires was reduced to 204 usable questionnaires through an empirical process of data cleaning. The study's hypotheses examined the extent to which involvement, satisfaction, and trust influence B2CVC stickiness and members' word-of-mouth. Structural Equation Modeling tested the hypotheses in the analysis, and the structural model fit indices were within accepted thresholds: ${\chi}^2^$/df was 2.76, NFI was .904, IFI was .931, CFI was .930, and RMSEA was .017. Results indicated that involvement has a significant influence on satisfaction (p<0.001, ${\beta}$=0.809). The proportion of variance in satisfaction explained by members' involvement was over half (adjusted $R^2$=0.654), reflecting a strong association. The effect of involvement on trust was also statistically significant (p<0.001, ${\beta}$=0.751), with 57 percent of the variance in trust explained by involvement (adjusted $R^2$=0.563). When the construct "stickiness" was treated as a dependent variable, the proportion of variance explained by the variables of trust and satisfaction was relatively low (adjusted $R^2$=0.331). Satisfaction did have a significant influence on stickiness, with ${\beta}$=0.514. However, unexpectedly, the influence of trust was not even significant (p=0.231, t=1.197), rejecting that proposed hypothesis. The importance of stickiness in the model was more significant because of its effect on e-WOM with ${\beta}$=0.920 (p<0.001). Here, the measures of Stickiness explain over eighty of the variance in e-WOM (Adjusted $R^2$=0.846). Overall, the results of the study supported the hypothesized relationships between members' involvement in a B2CVC and their satisfaction with and trust of it. However, trust, as a traditional measure in behavioral models, has no significant influence on stickiness in the B2CVC environment. This study contributes to the growing body of literature on B2CVCs, specifically addressing gaps in the academic research by integrating measures of beliefs, attitudes, and behaviors in one model. The results provide additional insights to behavioral factors in a B2CVC environment, helping to sort out relationships between traditional measures and relatively new measures. For practitioners, the identification of factors, such as member involvement, that strongly influence B2CVC member satisfaction can help focus technological resources in key areas. Global e-marketers can develop marketing strategies directly targeting B2CVC members. In the global tourism business, they can target Chinese members of a B2CVC by providing special discounts for active community members or developing early adopter programs to encourage stickiness in the community. Future studies are called for, and more sophisticated modeling, to expand the measurement of B2CVC member behavior and to conduct experiments across industries, communities, and cultures.

• Journal of Preventive Medicine and Public Health
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• v.35 no.2
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• pp.141-146
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• 2002

Objectives : This study was peformed in order to assess the incidence of hypertension based on two-years follow-up of a rural hypertension-free cohort in Korea. Methods : The study cohen comprised 2,580 subjects aged above 20 (1,107 men and 1,473 women) of Chung-Song County in Kyungpook Province judged to be hypertensive-free at the baseline examination in 1996. For each of two examinations in the two-year follow-up, those subjects free of hypertension were followed for the development of hypertension to the next examination one year (1997) and two years later (1998). The drop-out rate was 24.7% in men and 19.6% in women. Hypertension was defined as follows 1) above mild hypertension as a SBP above 140 mmHg or a DBP above 90 mmMg,2) above moderate hypertension as a SBP above 160 mmHg or a DBP above 100 mmHg or when the participant reported having used antihypertensive medication after beginning this survey. Results : The age-standardized incidence of above mild hypertension was 6 per 100 person years (PYS) in men and that of above moderate hypertension was 1.2. In women, the age-standardized rate for above mild hypertension was 5.7 and 1.5 for above mild and moderate hypertension, respectively. However, the rates of incidence as calculated by the risk method were 4.8% and 1.0% in men and 4.6%, 1.2% in women, respectively. In both genders, incidence was significantly associated with advancing age(p<0.01), In men, the incidences of above moderate hypertension by age group were 0.5 per 100 PYS aged 20-39, 0.7 aged 40-49, 1.7 aged 50-59, 3.6 aged 60-69, and 5.8 aged above 70(p<0.01). In women, those the incidence measured 0.6 per 100 PYS aged 20-39, 1.8 aged 40-49, 1.3 aged 50-59, 3.3 aged 60-69, and 5.6 aged above 70(p<0.01). After age 60, the incidence of hypertension increased rapidly. Conclusions : The incidence data of hypertension reported in this study may serve as a reference data for evaluating the impact of future public efforts in the primary prevention of hypertension in Korea.

• Journal of Preventive Medicine and Public Health
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• v.28 no.4 s.51
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• pp.809-844
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• 1995

The purposes of this study are to define the scope of occupational health management and to classify occupational management by review of related journals from 1945 to 1994 in Korea. The steps of this study were as follows: (1) Search of secondary reference; (2) Collection and review of primary reference; (3) Survey; and (4) Analysis and discussion. The results were as follows ; 1. Most of the respondents majored in occupational health(71.6%), and were working in university (68.3%), males and over the age 40. Seventy percent of the respondents agreed with the idea that classification of occupational health management is necessary, and 10% disagreed. 2. After integration of the idea of respondents, we reclassified the scope of occupational health management. It was defined 3 parts, that is , occupational health system, occupational health service and others (such as assessment, epidemiology, cost-effectiveness analysis and so on). 3. The number of journals on occupational health management was 510. It was sightly increased from 1986 and abruptly increased after 1991. The kinds of journals related to occupational health management were The Korean Journal of Occupational Medicine(18.2%), Several Kinds of Medical Colloge Journal(17.0%), The Korean Journal Occupational Health(15.1%), The Korean Journal of Preventive Medicine(15.1%) and others(34.6%). As for the contents, the number of journals on occupational health management systems was 33(6.5%) and occupational health services 477(93.5%). Of the journals on occupational health management systems, the number of journals on the occupational health resource system was 15(45.5%), occupational finance system 8(24.2%), occupational health management system 6(18.2%), occupational organization 3(9.1%) and occupational health delivery system 1 (3.0%). Of the journals on occupational health services, the number of journals on disease management was 269(57.2%), health management 116(24.7%), working environmental management 85(18.1%). As for the subjects, the number of journals on general workers was 185(71.1%), followed by women worker, white coiler workers and so on. 4. Respondents made occupational health service(such as health management, working environmental management and health education) the first priority of occupational health management. Tied for the second are quality analysis(such as education, training and job contents of occupational health manager) and occupational health systems(such as the recommendation of systems of occupational and general disease and occupational health organization). 5. Thirty seven respondents suggested 48 ideas about the future research of occupational health management. The results were as follows: (1) Study of occupational health service 40.5%; (2) Study of organization system 27.1%; (3) Study of occupational health system (e.g. information network) 8.3%; (4) Study of working condition 6.2%; and (5) Study of occupational health service analysis 4.2%.

• Journal of the Korean Institute of Traditional Landscape Architecture
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• v.40 no.2
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• pp.1-13
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• 2022

This paper examined the history and development of Gyeongbokgung Palace's back garden based on historical materials and drawings such as Joseon Ilgi(Diaries of Joseon Dynasty), Joseon Wangjo Sillok(the Annals of the Joseon Dynasty), Doseongdaejido(the Great Map of Seoul), Bukgwoldohyeong(Drawing Plan of the Northern Palace), the Bukgung Palace Restoration Plan, Restoration Planning of Gyeongbokgung Palace and the following results were derived. First, it was confirmed that the Back Garden of Gyeongbokgung Palace was famous for its great location since the Goryeo Dynasty, and that it was named Namkyeong at that time and was a place where a shrine was built, and that castles and palaces were already built during the Goryeo Dynasty under the influence of Fengshui-Docham(風水圖讖) and Zhouli·Kaogongji(周禮考工記). Although the back garden of Gyeongbokgung Palace in the early Joseon Dynasty stayed out of the limelight as a back garden for the palace, it has a place value as a living space for the head of the state from King Gojong to the present. Second, in order to clearly identify the boundaries of back garden, through literature such as map of Doseongdo (Map of the Capital), La Coree, Gyeongmudae Area, Japanese Geography Custom Compendium, Korean Photo Album, JoseonGeonchukdoJip(The Illustration Book of Joseon Construction), Urban Planning Survey of Gyeongseong, it was confirmed that the current Blue House area outside Sinmumun Gate was built outside the precincts of Gyeongbokgung Palace. It was found that the area devastated through the Japanese Invasion of Korea in 1592, was used as a space where public corporations were combined through the process of reconstruction during the King Gojong period. In Japanese colonial era, the place value as a back garden of the primary palace was damaged, as the palace buildings of the back garden was relocated or destroyed, but after liberation, it was used as the presidential residence and restored the place value of the ruler. Third, in the back garden of Gyeongbokgung Palace, spatial changes proceeded through the Japanese Invasion and Japanese colonial era. The place with the greatest geographical change was Gyeongnongjae area, where the residence of the Japanese Government-General of Korea was built, and there were frequent changes in the use of the land. On the other hand, the current Gyeongmudae area, the forests next to the small garden, and the forests of Baekak were preserved in the form of traditional forests. To clarify this, 1:1200 floor plan of inner Gyeongmudae residence and satellite images were overlapped based on Sinmumun Gate, and as a result, it was confirmed that the water path originating from Baekak still exists today and the forest area did not change. Fourth, in the areas where the traditional forest landscape was inherited, the functional changes in the topography were little, and major old-age colonies are maintained. The old trees identified in this area were indicator tree species with historical value. Representatively, Pinus densiflora for. multicaulis Uyeki, located in Nokjiwon Garden, is presumed to have been preserved as one of Pinus densiflora for. multicaulis Uyeki planted next to Yongmundang, and has a historicality that has been used as a photo zone at dinners for heads of state and important guests. Lastly, in order to continuously preserve and manage the value of Gyeongbokgung Palace in Blue House, it is urgent to clarify the space value through excavation of historical materials in Japanese colonial era and establish a hierarchy of garden archaeology by era. In addition, the basis for preserving the historical landscape from the Joseon Dynasty to the modern era from Gyeongbokgung Palace should not damage the area of the old giant trees, which has been perpetuated since the past, and a follow-up study is needed to investigate all the forests in Blue House.

• Journal of Preventive Medicine and Public Health
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• v.20 no.1 s.21
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• pp.165-203
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• 1987

This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

• Korean Journal of Health Education and Promotion
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• v.2 no.1
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• pp.3-50
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• 1984

The levels of health knowledge, attitude and practice of housewives considerably effect to the health of households, communities and the nation. This study was designed to grasp the levels of health knowledge, attitude and practice of houswives and analyse the various factors effecting to health in order to provide health education services as well as materials for effective formulation and implementation of health policy to improve the health of the nation. This study has been conducted through interviews by trained surveyers for 4,281 housewives selected from 4,500 households throughout the country for 40 days during July 11-August 20, 1983. The results of survey were analysed by stepwise multiple regression and path analysis are summarized as follows; 1. Based on the measurement instrument applied to this study, the levels of health knowledge, attitude and practice of housewives were extremely low with 54.5 points out of 100 points in full. Higher level with 72 points and above was approximately 21 percent and lower level with 39 points and below was approx. 24 percent. The middle level was approx. 55 percent. In order to implement health programs successively, health education should be more strengthened and to improve the level of health knowledge, attitude and practice (KAP) of the nation, political consideration as a part of spiritual reformation must be concentrated on health. 2. The level of health knowledge indicated the highest points with 57.3 the level of attitude was the second with 55.0 points and the practice level was the lowest with 50.0 point. Therefore, planning and implementation of health education program must be based on the persuasion and motivation that health knowledge turn into practice. 3. Housewives who had higher level of health knowledge, showed their practice level was relatively lower and those who had middle or low level of it practice level was the reverse. 4. Correlations among health knowledge, attitude and practice (KAP) were generally higher and statistically significant at 0.1 percent level. Correlation between total health KAP level and health knowledge was the highest with r=.8092. 5. Health KAP levels showed significant differences according to the age, number of children, marital status, self-assessed health status and concern on health of the housewives interviewed (p<0.001) 6. Health KAP levels also showed significant differences according to the education level, economic status, employment before marriage and grown-up area of the housewives interviewed. (p<0.001) 7. Heath KAP levels showed significant differences according to health insurance benificiary and the existence of patients in the family. (p<0.001). 8. Health KAP levels showed significant differences according to distance to government organizations, schools, distance to health facilities, telephone possession rate, television possession rate, newspaper reading rate and activities of Ban meeting and Women's club. (p<0.001) 9. Health KAP levels showed significant differences according to electric mass communication media such as television, radio and village broadcasting etc. and printed media such as newspaper, magazine and booklets etc., IEC variables such as individual consultation and husband-wife communication, however, there was no significance with group training. 10. Health KAP of the housewives showed close correlation with personal characteristics variables, i.e., education level (r=.5302), age (r=-.3694) grown-up area (r=.3357) and employment before marriage. In general, correlation of health knowledge level was higher than the levels of attitude or practice. In case of health concern and health insurance, correlation of practice level was higher than health knowledge level. 11. Health KAP levels showed higher correlation with community environmental characteristics, Ban meeting and activity of Women's club, however, no correlation with New-village movement. 12. Among IEC variables, husband-wife communication showed the highest correlation with health KAP levels and printed media, electric mas communication media and health consultation in order. Therefore, encouragement of husband-wife communication and development of training program for men should be included in health education program. 13. Mass media such as electric mass com. and printed media were effective for knowledge transmission and husband-wife communication and individual consultation were effective for health practice. Group training was significant for knowledge transmission, however, but not significant for attitude formation or turning to health practice. To improve health KAP levels, health knowledge should be transmitted via mass media and health consultation with health professionals and field health workers should be strengthened. 14. Correlation of health KAP levels showed that knowledge level was generally higher than that of practice and recognized that knowledge was not linked with attitude or practice. 15. The twenty-five variables effecting health KAP levels of housewives had 41 per cent explanation variances among which education level had great contribution (β=.2309) and electric mass com. media (β=.1778), husband-wife communication (β=.1482), printed media, grown-up area, and distance to government organizations in order. Variances explained (R²) of health KAP were 31%, 15%, and 30% respectively. 16. Principal variables contributed to health KAP were education level (β=.12320, β=.1465), electric mass comm. media (β=.1762, β=.1839), printed media, (β=.1383, β=.1420) husband-wife communication (β=.1004, β=.1067), grown-up area and distance to government organizations, in order. Since education level contributes greatly to health KAP of the housewives, health education including curriculum development in primary, middle and high schools must be emphasized and health science must be selected as one of the basic liberal arts subject in universities. 17. Variences explained of IEC variables to health KAP were 19% in total, 14% in knowledge, 9% in attitude, and 10% in health practice. Contributions of IEC variables to health KAP levels were printed media (β=.3882), electric mass comm media (β=.3165), husb-band wife com. (β=.2095,) and consultation on health (β=.0841) in order, however, group training showed negative effect (β=-.0402). National fund must be invested for the development of Health Program through mass media such as TV and radio etc. and for printed materials such as newspaper, magazines, phamplet etc. needed for transmission of health knowledge. 18. Variables contributed to health KAP levels through IEC variables with indirect effects were education level (Ind E=0.0410), health concern (Ind E=.0161), newspaper reading rate (Ind E=.0137), TV possession rate and activity of Ban meeting in order, however, health facility showed negative effect (Ind E=-.0232) and other variables showed direct effect but not indirect effect. 19. Among the variables effecting health KAP level, education level showed the highest in total effect (TE=.2693) then IEC (TE=.1972), grown-up city (TE=.1237), newspaper reading rate (TE=.1020), distance to government organization (TE=.095) in order. 20. Variables indicating indirect effects to health KAP levels were; at knowledge level with R²=30%, education level (Ind E=.0344), newspaper reading rate (Ind E=.0112), TV possession rate (Ind E=.0689), activity of Ban meeting (Ind E=.0079) in order and at attitude level with R²=13%, education level (Ind E=. 0338), activity of Ban meeting (Ind E=.0079), and at practice level with R²=29%. education level (Ind E=.0268), health facility (Ind E=.0830) and concern on health (Ind E=.0105). 21. Total effect to health KAP levels and IEC by variable characteristics, personal characteristics variables indicated larger than community characteristics variables. 22. Multiple Correlation Coefficient (MCC) expressed by the Personal Characteristic Variable was .5049 and explained approximately 25% of variances. MCC expressed by total Community environment variable was .4283 and explained approx. 18% of variances. MCC expressed by IEC Variables was .4380 and explained approx. 19% of variances. The most important variable effected to health KAP levels was personal characteristic and then IEC variable, Community Environment variable in order. When the IEC effected with personal characteristic or community characteristic, the MCC or the variances were relatively higher than effecting alone. Therefore it was identified that the IEC was one of the important intermediate variable.